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Course: Oncology Nursing

Topic: Nursing Management of

Self-esteem and Body Image Concerns in Cancer Patients

The Nurses International Community

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COPYRIGHT

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Module Goals

Learners will be able to:

Describe the definition of self-esteem and body image.
Identify patient's concerns regarding body image and self-esteem as a consequence of cancer treatment.
Discuss ways to improve body image and self-esteem in the nursing management of cancer patients.
Identify information for patient education/counseling on self-esteem management and positive image at home.

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Body Image and Self-esteem : Definition

National Cancer Institute, n.d., Body image.
Fingeret et al. (2014)
National Cancer Institute, n.d., Definition- Self-esteem.

Body image or self-image can be defined as the way a person thinks about his or her body and how it looks to others¹.
Body image has also been defined as multifaceted construct that involves perceptions, thoughts, feelings, and behaviours related to the entire body and its functioning².
Self-esteem can be defined as a feeling of self-worth, self-confidence, and self-respect³.

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Body Image and Self-esteem and Cancer

Cancer/its treatment can cause changes in body functions or its look^1,2:

Loss of hair
Weight loss or weight gain
Issues with bladder or bowel control
Losing a body part/scarring
Having stoma
Infertility
Sexual difficulties
Dysphagia
Dysarthria

Structural/functional changes in body shown to negatively impact patient’s body image and self-esteem^1,2.

has strong implications for psychological adjustment and social functioning with peers^2,3.

National Cancer Institute, n.d., Body image
Fingeret et al. (2014)
Leite et al. (2015)

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Cancer Treatment Impact on Body Image

Structural changes in the body can cause patient to feel¹:

Grief and sadness about changes in the body²
Concern or embarrassment about how body looks
Feeling unattractive
Fear of how the changes will affect relationship
Anger that body has let her/him down and isn’t the same³
Fear of what other people think
Feel less feminine or less masculine

New South Wales Government website, Body image and self-confidence.
Fingeret et al. (2014)
Canadian Cancer Society, n.d., Coping with body image and self-esteem worries.

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Cancer Treatment Impact on Self-esteem

Cancer and its treatment can cause patient to:

Feel loss of control
At times find it difficult to think and make decisions
Feel more emotional or angry
Worry how body looks or functions
Limit activities they enjoy due to side-effects like fatigue, pain, etc
Change relationships with partner/family/friends/colleagues

All of the above can affect patient’s self-esteem by hampering their sense of independence, self-worth, and self-respect

New South Wales Government website, Body image and self-confidence.
Canadian Cancer Society, n.d., Coping with body image and self-esteem worries.

Contact info: info@nursesinternational.org

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Take a moment and think…..

Why should patient’s difficulties with body image and self-esteem need to be addressed?

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Examples of Body Image/Self-esteem Difficulties

A woman with breast cancer tells her treatment team she can no longer stand to look at herself in the mirror or show her body to her husband after a mastectomy.

A man who underwent an orbital exenteration rarely leaves the house because he does not want others staring or making comments about his appearance. He is particularly scared of what his grandchildren think of him when they see him.

A woman who underwent partial glossectomy and radical neck dissection has debilitating anxiety about returning to work and being around others because of her unclear speech and difficulties with eating.

Source: Fingeret et al. (2014)

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Examples of Body Image/Self-esteem Difficulties

A patient with diffuse large B cell lymphoma undergoing chemotherapy recently lost her hair and a significant amount of weight. She experiences daily crying spells about her body changes and is preoccupied with whether her hair will grow back differently.

A male patient with rectal cancer is refusing to undergo treatment due to concerns that he will not be able to conceal his colostomy bag from others and that his spouse will no longer find him sexually attractive.

Fingeret et al. (2014)

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Consequences of Body Image/ Self-esteem Difficulties

Fingeret et al. (2014)
Leite et al. (2015)

Interfere with cancer treatment

Refusal of treatment¹
Problems with compliance of treatment²
Uptake unhealthy behaviours like smoking, alcohol consumption²

Unable to resume routine activities¹
Become reclusive, social isolation¹
Diminished quality of life^1,2

Ongoing distress, anxiety, or depression

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Potential Indicators of Body Image Difficulties

Fingeret and her friends (2014) listed following as potential indicators of body image difficulties:

Unrealistic expectations about treatment outcomes for appearance and functioning.
Preoccupied with concerns about upcoming appearance changes.
Difficulties making treatment decisions due to concerns about appearance/body changes.
Difficulties with or avoidance of viewing oneself after treatment.
Highly dissatisfied with appearance outcome following treatment.

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Potential Indicators of Body Image Difficulties

Continued……

Preoccupied with perceived or actual physical flaws resulting from cancer and/or its treatment.
Avoidance social situations due to appearance/body changes.
Romantic relationship distress due to body image changes.
Considerable time and effort spent in appearance-fixing behaviors.
Persistent distress, anxiety or depression due to body image changes.

Fingeret et al. (2014)

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Take a moment and think……

How can the health care providers address the body image and self-esteem difficulties of cancer patient?

Contact info: info@nursesinternational.org

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Framework for Discussing Body Image Difficulties

Fingeret proposed a conceptual framework for approaching conversations about body image, referred to as The Three C’s (Fingeret, 2010, as cited in Fingeret et al., 2014):

At the beginning of a clinical encounter, remind patients that body image difficulties are very common as a result of cancer/its treatment

reduces shame, embarrassment, and stigma

Then providers should ask patient what specific concerns they have related to body image.
Finally, ask patient about consequences of their body image difficulties or impact on daily functioning.

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Management of Body Image/Self-esteem Difficulties

Encourage patient to express themselves:

Ask open ended questions

like- “Tell me more” or “What is that like for you”

Active listening is highly therapeutic

Make patient feel they are heard

Create space in the conversation by allowing for silence

often yield information on patient’s values, fears, concerns

Interjecting brief phrases without actually interrupting shows patients we are tuned in

eg, “What else?”, “I see…”

Fingeret et al. (2014)

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Management of Body Image/Self-esteem Difficulties

Fingeret et al. (2014)

Patient emotional moments can be explicit or implicit

e.g. explicit: “I am scared”, or display anger

implicit: look sad or anxious

Avoid providing premature reassurances

e.g “You look great” or “Stop worrying, in a few months you will look completely normal”

Stay with the emotions few minutes longer.
Offer reassurance, education, and further treatment options only after patients have had chance to express their concerns.

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Management of Body Image/Self-esteem Difficulties

Address body image concerns with patients who-

Voluntarily raise concerns
Behave in ways that indicate body image difficulties

Provide patient teaching on what to expect in terms of appearance and functional outcomes with cancer/cancer treatment
Connect patient to relevant community resources

Support programs, support groups

Refer patients to mental health specialist for brief or intensive therapy where needed
Follow-up with patients with known body issues/self-esteem difficulties

Fingeret et al. (2014)

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Patient Teaching for Promoting Self-confidence

Cancer Australia, n.d., Cancer and self-confidence.
Martinez L.M. (2019)

Encourage patient to allow themselves time to adapt to the changes^1,2.
Encourage patients to draw attention to their strengths¹.
Encourage patients to stay active and exercise regularly as possible^1,2.

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Take a moment and think……

What are nurse’s role in management of body image/self-esteem difficulties of cancer patients?

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Nurse’s Role in Management of Body Image/Self-esteem Difficulties

Be vigilant for signs/symptoms of body image and self-esteem difficulties in patient.
Address the body image/self-esteem difficulties with patients appropriately.
All nursing encounters with patient must promote patient’s dignity.

Assist patient activities in respectful manner.
Commend patients efforts.

Provide emotional support to the patient and let them know that they are not alone.

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Nurse’s Role in Management of Body Image/Self-esteem Difficulties

Encourage patients to give themselves time to adjust to the change².
Refer to relevant community resources.
Provide informations on different alternatives like prosthesis, cosmetic options, etc.

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Reference:

Cancer Australia (n.d.). Cancer and Self-confidence. Australia Government. Accessed from: https://www.canceraustralia.gov.au/affected-cancer/living-cancer/managing-emotional-changes/cancer-and-self-confidence

Canadian Cancer Society (n.d.). Coping with body image and self-esteem worries. Accessed from: https://www.cancer.ca/en/cancer-information/living-with-cancer/your-emotions-and-cancer/coping-with-body-image-and-self-esteem/?region=on

Fingeret M. C., Teo I., & Epner D. E. (2014). Managing body image difficulties of adult cancer patients: lessons from available research. Cancer, 120(5), 633–641. https://doi.org/10.1002/cncr.28469

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Reference:

Leite, M. A., Nogueira, D. A., & Terra, F. (2015). Evaluation of self-esteem in cancer patients undergoing chemotherapy treatment. Revista latino-americana de enfermagem, 23(6), 1082–1089. Accessed from: https://doi.org/10.1590/0104-1169.0575.2652

Martinez, L.M.. (2019). Body Image and Self-Esteem in Patients With Cancer. Oncology Nursing News. Accessed from: https://www.oncnursingnews.com/view/body-image-and-self-esteem-in-patients-with-cancer

National Cancer Institute (n.d.). Body image. Accessed from: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/body-image

Contact info: info@nursesinternational.org

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Reference:

National Cancer Institute (n.d.). Definition Self-esteem. Accessed from: https://www.cancer.gov/search/results?swKeyword=self-esteem

New South Wales Government website (n.d.). Body image and self-confidence. Accessed from: https://www.cancer.nsw.gov.au/general-cancer-information/cancer-support/coping-with-cancer/emotional-wellbeing/body-image-and-self-confidence

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